title: Asthma outcomes are poor among older adults with low health literacy.
abstract: OBJECTIVE
  To examine the association of health literacy (HL) with asthma outcomes among older asthmatics.
  
  
  METHODS
  The study included adults ages ≥60 with moderate to severe asthma in New York City and Chicago. We assessed asthma control with the Asthma Control Questionnaire (ACQ) and the percent predicted forced expiratory volume at 1 s (FEV1) by spirometry, hospitalizations and emergency department (ED) visits in the past 6 months, and quality of life. HL was assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Multivariate logistic regression models controlled for age, sex, race, income, general health and years with asthma.
  
  
  RESULTS
  Among 433 individuals, 36% had low HL, 55% were over age 65, 38% were Hispanic and 22% were black. Poor asthma control was reported by 40% and 32% had FEV1 <70% of predicted; 9% had a hospital stay, 23% had an ED and 38% had poor quality of life. In multivariable analysis, individuals with low HL were more likely to have FEV1 <70% predicted (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.39-3.94, p = 0.001), hospitalizations (OR 2.53, 95% CI 1.17-5.49, p = 0.02) and ED visits for asthma (OR 1.81, 95% CI 1.05-3.10, p = 0.03). There were no differences in self-reported asthma control and quality of life.
  
  
  CONCLUSIONS
  Low HL is associated with poor asthma control by objective measure, and greater likelihood of ED visits and hospitalization. HL is a modifiable target for interventions to improve asthma outcomes in the elderly.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine , New York, NY , USA .
authors.forename: Alex D
authors.initials: AD
authors.lastname: Federman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Anastasia
authors.initials: A
authors.lastname: Sofianou
authors.forename: Rachel
authors.initials: R
authors.lastname: O'Conor
authors.forename: Melissa
authors.initials: M
authors.lastname: Martynenko
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Howard
authors.initials: H
authors.lastname: Leventhal
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000368:Aged; D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D002641:Chicago / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005541:Forced Expiratory Volume; D057220:Health Literacy / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires